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Sun X.,Childrens Hospital of Eastern Ontario CHEO | Lemyre B.,Gynecology and Newborn Care | Nan X.,Childrens Hospital of Eastern Ontario CHEO | Harrold J.,Childrens Hospital of Eastern Ontario CHEO | And 2 more authors.
Clinical Biochemistry

Objectives: To establish reference intervals for thyroid stimulating hormone (TSH) and free thyroxine (FT4) at 3-6. weeks of age in very low birth weight (VLBW) infants with the Beckman Coulter Unicel DxI 800 by gender, birth weight (BW) and gestational age (GA) subgroups. Design and methods: A 4. year retrospective cohort of 308 VLBW infants (GA = 27.9. weeks, BW = 992.3. g) was studied. All blood samples for TSH and FT4 were analyzed using the modified fTSH2 (TSH) and two-step competitive enzyme immunoassay (FT4). Reference intervals were evaluated according to the most recent Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The study provides non-parametric 95% reference intervals with associated 90% confidence intervals for FT4 and TSH derived from 308 infants screened at a median of 31. days. The reference intervals for this population are TSH = 1.14-11.04. mIU/L and FT4 = 10.9-21.4. pmol/L. TSH statistically differed according to birth weight (<. 1000. g vs 1000-1499. g) while FT4 differed according to gender and gestational age at time of testing (<. 32. weeks vs ≥. 32. weeks); however, these differences were not clinically significant and a single reference interval for each analyte is reported. Conclusion: The results of this study highlight the importance and complexity of establishing appropriate reference intervals for thyroid function testing for the preterm population. © 2013 The Canadian Society of Clinical Chemists. Source

Tremblay E.,Universite de Sherbrooke | Ferretti E.,CHEO | Babakissa C.,Universite de Sherbrooke | Seidman E.G.,McGill University | And 3 more authors.
Journal of Pediatric Gastroenterology and Nutrition

Background and Objectives: The occurrence of many neonatal inflammatory intestinal diseases in preterm infants highlights the susceptibility of the immature intestine to responding inadequately to nutrients and microbes. A better understanding of functional intestinal development is essential for the design of optimal treatments ensuring survival and growth of premature infants. The purpose of this study was to evaluate the gene expression profiles of the human ileum and colon at mid-gestation because these 2 segments are considered to be similar at this stage and are the sites of the most frequent pathologies in preterm infants. Subjects and Methods: We compared the gene-expression profiles of human fetal small and large intestines using a cDNA microarray and analyzed the data with Ingenuity Pathway Analysis software. Results: We found that a significant proportion of the genes was differentially expressed in the 2 segments. Gene cluster analysis revealed an even higher level of transcriptional dissimilarity at the functional level. For instance, segment-specific/overexpressed gene clusters in the ileum included genes involved with amino acid, vitamin, and mineral metabolism, reflecting the higher level of maturity of the small intestine as compared with the colon in which genes involved with cell cycle, cell death, and cell signaling were the predominant clusters of genes expressed. Conclusions: Functional clustering analysis of the differentially expressed genes revealed important functional differences between the 2 segments and a relative immaturity of the colon, suggesting that already at mid-gestation, the 2 intestinal segments should be considered as 2 distinct organs. Copyright © 2011 by ESPGHAN and NASPGHAN. Source

Objective: To document the legal guardian-related barriers to consent procurement, and their stated reasons for non-participation in a paediatric critical care research study. Study design: A multicentre, prospective, cohort study. Participants: Legal guardians of children who participated in a multicentre study on adrenal insufficiency in paediatric critical illness. Data were collected on all consent encounters in the main study. Methods: Screening data, reasons for consent not being obtained, paediatric risk of mortality (illness severity) scores and age were collected on all 1707 patients eligible for participation in the Adrenal Insufficiency Study. Results: The main barriers to approaching legal guardians for consent were lack of availability of the legal guardians (321/1707) and language barriers (84/1707). Legal guardians of 917 patients were approached with an overall consent rate of 42% (range 14-56% across the seven sites). 81% of the 528 legal guardians who declined consent provided an unsolicited reason for refusal. The three most commonly stated reasons were: being overwhelmed (117/429), not wanting anything else done to their child (63/429) and not wanting an additional medication (53/429). In addition, 14.2% cited research-related concerns as the reason for their non-participation. Conclusions: Barriers to consent procurement in a non-therapeutic paediatric critical care study appear to occur at many levels with lack of availability of legal guardians, and legal guardians feeling overwhelmed, being the most commonly recorded reasons. Further research into the impact of these findings on the validity and generalisability of the results of such studies is necessary prior to the development and study of future consent models. Source

Schuler J.E.,University of Ottawa | James King W.,University of Ottawa | Dayneka N.L.,CHEO | Rastelli L.,Childrens Hospital of Eastern Ontario CHEO | And 3 more authors.
Canadian Journal of Public Health

Background: In Canada, the pH1N1 influenza vaccine is recommended for children, particularly those less than 5 years of age or with chronic underlying disease. The pH1N1 vaccine, which contains residual allergenic egg white proteins, may pose a risk for vaccination of egg-allergic children. Objective: To describe the outcome of pH1N1 influenza vaccine administration to egg-allergic children at risk for severe H1N1 disease. Design/Method: Prospective observational cohort study. Children identified as at high risk for egg allergy and H1N1 influenza were vaccinated using a two-dose split protocol in a controlled medical setting. Children were given an initial test dose; if no reaction was noted, the remainder of the dose was administered and the children were followed for allergic reactions. Those who tolerated the split dose and required a second dose of vaccine were offered vaccination four weeks later as one injection. Results: Sixty-two egg-allergic children considered at high risk for H1N1 disease received the adjuvanted pH1N1 vaccine. Egg allergy was diagnosed both clinically by an allergist and using skin and/or serum IgE testing. Within one hour of immunization, 2 children developed hives, 1 had a vasovagal response and 1 had a hypo-responsive episode. Fourteen children received the second H1N1 dose and 1 developed erythema and itching. There were no anaphylactic reactions. Conclusion: Administration of the adjuvanted pH1N1 vaccine in egg-allergic children at risk for severe H1N1 influenza was safe when performed in a two-dose split protocol in a controlled medical setting. © Canadian Public Health Association, 2011. Source

Zhang Y.R.,CHEO | Ogungbemile A.,CHEO | Janvier M.-A.,CHEO | Greenwood K.,Childrens Hospital of Eastern Ontario CHEO
Journal of Clinical Engineering

This article is written based on the experiences from the Children's Hospital of Eastern Ontario in Ottawa. Pediatric hospitals tend to be more equipment intensive than their adult counterparts; to further complicate the situation, manufacturers often do not pursue the development of equipment for this specializedmarket because of the high cost of Research & Development and the relatively small customer base.1 One might even tend to think that many companies have adapted their adult device designs to pediatric usage as an afterthought, with mixed results for performance. Pediatric institutions face a different set of challenges when it comes to ensuring patient safety while continuing to strive to provide state-of-the-art services with matching technologies. Management of the pediatric patient is much more daunting than one would imagine: patient age varies fromnewborn (neonatal) to 18 years old (young adult). Pediatric body weight ranges from 0.5 to 200+ kg, which is a 400-fold range, whereas in the adut setting it is a much narrower weight range with a 5-fold maximumspan. The BSA (body surface area)YtoYmass ratio could be 3 times larger for an infant when compared with an adult.2 Children's bodies have different operational requirements to those of adults.3 As a result, pediatric hospitals have to hold a wide range of devices that will accommodate this diverse patient population accompanied by consumables needed to cover the full range of patients. Furthermore, storage space for this expanded equipment inventory and the related consumables is a common problem. Consumable supply inventory is often hard to predict because the age group and acuity of patient fluctuate. All of these factors have a marked impact on both the capital and operating budget of a facility and indirectly impact patient care. In addition, each clinical department within a pediatric facility is presented with its own subset of challenges when faced with lack of pediatric-specific devices.4 This article presents a few different cases on his theme of the challenges for optimizing new medical technologies in the pediatric healthcare environment, to give the reader a perspective on this issue. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Source

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